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. 2005 Oct 14;60(12):1059–1065. doi: 10.1136/thx.2005.045880

What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study

W Hamilton 1, T Peters 1, A Round 1, D Sharp 1
PMCID: PMC1747254  PMID: 16227326

Abstract

Background: Over 38 000 new cases of lung cancer occur each year in the UK. Most are diagnosed after initial presentation to primary care, but the relative importance of the various clinical features is largely unknown.

Methods: A population based case-control study was undertaken in all 21 general practices in Exeter, Devon, UK (population 128 700). 247 primary lung cancers were studied in subjects aged over 40 years diagnosed between 1998 and 2002 and 1235 controls matched by age, sex and general practice. The entire primary care record for 2 years before diagnosis was coded using the International Classification of Primary Care-2. Univariable and multivariable conditional logistic regression analyses were used to identify and quantify clinical features independently associated with lung cancer. The main outcome measures were odds ratios and positive predictive values for these variables.

Results: Seven symptoms (haemoptysis, loss of weight, loss of appetite, dyspnoea, thoracic pain, fatigue and cough), one physical sign (finger clubbing), and two abnormal investigation results (thrombocytosis and abnormal spirometry) were associated with lung cancer in multivariable analyses, as was cigarette smoking. After excluding variables reported in the final 180 days before diagnosis, haemoptysis, dyspnoea and abnormal spirometry remained independently associated with cancer.

Conclusions: This study provides an evidence base for selection of patients for investigation of possible lung cancer, both for clinicians and for developers of guidelines.

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Selected References

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  1. Colice G. L. Detecting lung cancer as a cause of hemoptysis in patients with a normal chest radiograph: bronchoscopy vs CT. Chest. 1997 Apr;111(4):877–884. doi: 10.1378/chest.111.4.877. [DOI] [PubMed] [Google Scholar]
  2. Corner J., Hopkinson J., Fitzsimmons D., Barclay S., Muers M. Is late diagnosis of lung cancer inevitable? Interview study of patients' recollections of symptoms before diagnosis. Thorax. 2005 Apr;60(4):314–319. doi: 10.1136/thx.2004.029264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fergusson R. J., Gregor A., Dodds R., Kerr G. Management of lung cancer in South East Scotland. Thorax. 1996 Jun;51(6):569–574. doi: 10.1136/thx.51.6.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ford Leslie G., Minasian Lori M., McCaskill-Stevens Worta, Pisano Etta D., Sullivan Dan, Smith Robert A. Prevention and early detection clinical trials: opportunities for primary care providers and their patients. CA Cancer J Clin. 2003 Mar-Apr;53(2):82–101. doi: 10.3322/canjclin.53.2.82. [DOI] [PubMed] [Google Scholar]
  5. Gallagher Arlene M., Thomas Janice M., Hamilton William T., White Peter D. Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. J R Soc Med. 2004 Dec;97(12):571–575. doi: 10.1258/jrsm.97.12.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hamilton William, Sharp Deborah. Diagnosis of lung cancer in primary care: a structured review. Fam Pract. 2004 Nov 1;21(6):605–611. doi: 10.1093/fampra/cmh605. [DOI] [PubMed] [Google Scholar]
  7. Hippisley-Cox Julia, Pringle Mike, Cater Ruth, Wynn Alison, Hammersley Vicky, Coupland Carol, Hapgood Rhydian, Horsfield Peter, Teasdale Sheila, Johnson Christine. The electronic patient record in primary care--regression or progression? A cross sectional study. BMJ. 2003 Jun 28;326(7404):1439–1443. doi: 10.1136/bmj.326.7404.1439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jemal Ahmedin, Murray Taylor, Ward Elizabeth, Samuels Alicia, Tiwari Ram C., Ghafoor Asma, Feuer Eric J., Thun Michael J. Cancer statistics, 2005. CA Cancer J Clin. 2005 Jan-Feb;55(1):10–30. doi: 10.3322/canjclin.55.1.10. [DOI] [PubMed] [Google Scholar]
  9. Kamiński J. Czestoś wystepowania i przyczyna krwiopluć znaczenie badania bronchofiberoskopowego u chorych z prawidłowym obrazem radiologicznym płuc hospitalizowanych w Klinice Ftizjopneumonologii Slaskiej Akademii Medycznej w Zabrzu w latach 1961-96. Pneumonol Alergol Pol. 2001;69(11-12):663–668. [PubMed] [Google Scholar]
  10. Koyi Hirsh, Hillerdal Gunnar, Brandén Eva. A prospective study of a total material of lung cancer from a county in Sweden 1997-1999: gender, symptoms, type, stage, and smoking habits. Lung Cancer. 2002 Apr;36(1):9–14. doi: 10.1016/s0169-5002(01)00451-2. [DOI] [PubMed] [Google Scholar]
  11. Kuyvenhoven M. M., Spreeuwenberg C., Touw-Otten F. W. Diagnostic styles of general practitioners confronted with ambiguous symptoms. An exploratory study. Scand J Prim Health Care. 1989 Mar;7(1):43–48. doi: 10.3109/02813438909103670. [DOI] [PubMed] [Google Scholar]
  12. Metcalf J. V., Smith J., Jones R., Record C. O. Incidence and causes of rectal bleeding in general practice as detected by colonoscopy. Br J Gen Pract. 1996 Mar;46(404):161–164. [PMC free article] [PubMed] [Google Scholar]
  13. Mulshine J. L., Smith R. A. Lung cancer. 2: screening and early diagnosis of lung cancer. Thorax. 2002 Dec;57(12):1071–1078. doi: 10.1136/thorax.57.12.1071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Månsson J., Bengtsson C. Pulmonary cancer from the general practitioner's point of view. Experience from the health centre area of Kungsbacka, Sweden. Scand J Prim Health Care. 1994 Mar;12(1):39–43. doi: 10.3109/02813439408997055. [DOI] [PubMed] [Google Scholar]
  15. Nielsen L. S., Svanegaard J., Wiggers P., Egeblad H. The yield of a diagnostic hospital dyspnoea clinic for the primary health care section. J Intern Med. 2001 Nov;250(5):422–428. doi: 10.1046/j.1365-2796.2001.00901.x. [DOI] [PubMed] [Google Scholar]
  16. Okkes I. M., Oskam S. K., Lamberts H. The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. J Fam Pract. 2002 Jan;51(1):31–36. [PubMed] [Google Scholar]
  17. Pedersen Lars M., Milman Nils. Diagnostic significance of platelet count and other blood analyses in patients with lung cancer. Oncol Rep. 2003 Jan-Feb;10(1):213–216. [PubMed] [Google Scholar]
  18. Skillrud D. M., Offord K. P., Miller R. D. Higher risk of lung cancer in chronic obstructive pulmonary disease. A prospective, matched, controlled study. Ann Intern Med. 1986 Oct;105(4):503–507. doi: 10.7326/0003-4819-105-4-503. [DOI] [PubMed] [Google Scholar]
  19. Smith Robert A., Cokkinides Vilma, Eyre Harmon J. American Cancer Society Guidelines for the Early Detection of Cancer, 2005. CA Cancer J Clin. 2005 Jan-Feb;55(1):31–56. doi: 10.3322/canjclin.55.1.31. [DOI] [PubMed] [Google Scholar]
  20. Summerton Nicholas. Cancer recognition and primary care. Br J Gen Pract. 2002 Jan;52(474):5–6. [PMC free article] [PubMed] [Google Scholar]
  21. Thiru Krish, Hassey Alan, Sullivan Frank. Systematic review of scope and quality of electronic patient record data in primary care. BMJ. 2003 May 17;326(7398):1070–1070. doi: 10.1136/bmj.326.7398.1070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Tockman M. S., Anthonisen N. R., Wright E. C., Donithan M. G. Airways obstruction and the risk for lung cancer. Ann Intern Med. 1987 Apr;106(4):512–518. doi: 10.7326/0003-4819-106-4-512. [DOI] [PubMed] [Google Scholar]
  23. de Lusignan S., Minmagh C., Kennedy J., Zeimet M., Bommezijn H., Bryant J. A survey to identify the clinical coding and classification systems currently in use across Europe. Stud Health Technol Inform. 2001;84(Pt 1):86–89. [PubMed] [Google Scholar]

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